• Characteristics of Hospital Inpatient Charges, Length of Stay, and Inpatient Mortality in Patients with Ovarian Cancer from 2002-2005

      Skrepnek, Grant; Fletcher, Emily A.; Lawson, Robert S.; College of Pharmacy, The University of Arizona (The University of Arizona., 2009)
      OBJECTIVES: To determine and characterize the relative impact of patient demographics on hospital inpatient charges, length of stay, and inpatient mortality in patients with ovarian cancer from 2002-2005. METHODS: A retrospective database analysis of AHRQ’s Health Care Cost and Utilization Project (HCUP) Nationwide Inpatient Sample databases was conducted spanning from January 1, 2002, to December 31, 2005.Data were collected regarding age, race, payer status, median household income, location of hospital (urban/rural), comorbidities, procedures, total charges, length of stay, and inpatient mortality. Multivariate and gamma regression methods were utilized to examine incremental risks associated with length of stay, total charges, and inpatient mortality, after controlling for all other variables. RESULTS: Overall, data from 246,012 hospital admissions were obtained. The average length of stay of patients was 6.58 days (SD = 7.22), the average number of diagnoses was 7.18 (SD = 3.36), the average number of procedures performed was 2.71 (SD = 2.66). A total of 14,485 (5.9%) patients died during hospitalization. The average total charge was $29,698 (SD = $42,951). The IRR was 0.886 (95%CI, -0.105 to -0.04) for patients who were Hispanic, and 1.089 (95%CI, 0.017–0.153) for patients who were Black compared to patients who were white. When compared to patients who lived in large, metropolitan areas, the IRR was 0.88 (95%CI, -0.146 to - 0.109) for patients located in smaller, metropolitan areas, and the IRR was 0.74 (95%CI, -0.335 to -0.268) for patients located in non- urban areas. CONCLUSIONS: Patient demographics were found to have associations, both directly and indirectly, with length o
    • Clostridium difficile Infection (CDI) Incidence Rate and CDI-Associated Length of Stay, Total Hospital Charges and Mortality

      Nix, David; Skrepnek, Grant; Sundareshan, Padma; College of Pharmacy, The University of Arizona (The University of Arizona., 2009)
      OBJECTIVES: The purpose of the study was to determine the rate of Clostridium difficile infections (CDI) in hospitalized patients and the various factors that were associated with the risk of developing CDI by examining patient discharge data for hospitals in 37 states in the United States using Healthcare Cost and Utilization Project (HCUP). METHODS: Patient discharge information for all patients obtained using HCUP census for the years 2002-2005, either for primary or secondary (all-listed) occurrences of CDI using the ICD-9-CM code (008.45) specific for intestinal infections due to C. difficile, were included in the study. Regression analysis, either Generalized Linear Model log-link or power-link, or a logistic regression was employed to control for the multiple independent variables. RESULTS: The incidence rate for CDI was 9.4% for the years 2002-2005. Among the concomitant diagnoses and procedures, essential hypertension, volume depletion, congestive heart failure, urinary tract infection and venous catheterization were the top 5. The length of stay (LOS) for CDI was associated with being Black, Hispanic or Other race category, number of diagnoses and procedures, primary expected payer of Medicaid, private insurance and other (including worker’s compensation, CHAMPUS,CHAMPVA etc), and all groups classified based on median household income category for patient’s zip code. Predictors of CDI related to inpatient total hospital charges were being female, race (other than black), number of diagnoses and procedures, Death, LOS, patient location and with self-pay and no charge categories as primary expected payer. Predictors of higher CDI related inpatient hospital deaths were age, female sex, Hispanic race, number of diagnoses and procedures, LOS and having Medicaid, self-pay or other as primary expected payer. CONCLUSIONS: LOS, inpatient total hospital charges, and inpatient mortality were dependent on several patient and other characteristics.
    • Comparison of Length of Hospital Stay and Cost of Intravenous and Oral N-acetylcysteine in Acute Acetaminophen Toxicity

      Armstrong, Edward; Moreno, Jazmin; Porras, Misael; Armstrong, Edward; College of Pharmacy, The University of Arizona (The University of Arizona., 2014)
      Specific Aims: To determine the cost of treatment of oral and intravenous n-acetylcysteine (IV NAC) in acute acetaminophen (APAP) toxicity using the length of treatment and length of hospital stay. Methods: A retrospective chart review of Arizona Poison and Drug Information Center electronic records from 2009-2012 and January-June 2013 were evaluated. The following information was collected: age, sex, use oral or intravenous NAC, length of treatment, length of hospital stay (intensive care unit (ICU) and non-ICU) and use of antiemetic. The mean length of stay (MLOS) was calculated for each group as well as the cost of IV and oral NAC. These means were then compared using t-test for independent groups to test for significance. The average total cost of IV and oral NAC treatment was calculated by using monetary values from primary literature. A sensitivity analysis was performed to test the possible effects of an increase or decrease of the final costs by 5 to 10%. Main Results: Patients (≥18 yrs) being treated with IV or oral NAC for acute APAP toxicity (≤8 hours prior to ingestion) were included in this study. A total of 47 patients met the inclusion criteria. Length of hospital stay was shorter in patients receiving IV NAC (42.5% 24-24hr; 37.5% 48-72hr) compared to patients receiving oral NAC (28.6% 48-72hr, 71.4% >72hrs; p<0.001). Total cost of ICU/non-ICU stay in patients receiving IV NAC ($8,720/$3010) was less than patients receiving oral NAC ($12,321/$4703); however, cost of IV NAC-extended (37hrs) in ICU/non-ICU ($13,153/$5535) was greater than oral NAC. The sensitivity analysis performed demonstrated that an increase or a decrease by 5 to 10% in change of cost does not affect our final conclusion. Conclusion: The cost of treatment of IV NAC is lower due to shorter LOS of patients treated with IV NAC (p<0.001). However, when an extended course of treatment is medically necessary for patients on IV NAC then the cost of treatment with IV NAC exceeds the cost of treatment with oral NAC.
    • Oseltamivir Prescribing Practices for Influenza in Patients in the Intensive Care Unit and Associated Outcomes

      Erstad, Brian; Oman, Nathaniel; Vraney, Jamie; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: To assess appropriateness of prescribing practices of oseltamivir to package insert recommendations and identify significant differences in length of intensive care unit (ICU) stay, length of mechanical ventilation, and mortality in critically ill patients with influenza who received oseltamivir within 48 hours of symptom onset compared to those who did not. Methods: Patients were included in this retrospective, Institutional Review Board (IRB)-approved chart review if they were at least 18 years old with confirmed diagnosis of influenza in an intensive care unit at Banner University Medical Center – Tucson from 2015-2016. Categorical data were analyzed using Fisher’s exact test. Continuous variables were analyzed using a two-sample T-test assuming equal variances. The alpha priori level was 0.05. Main Results: All patients with confirmed influenza were treated with oseltamivir. 52% of patients received oseltamivir within 48 hours of symptom onset and 55% received an appropriate dose based on renal function. 30% of patients received oseltamivir for the recommended 5-day duration. Oseltamivir was prescribed with correct onset, dose, and duration based on package insert recommendations in only 3 instances (9.1%). No difference was seen in ICU length of stay (p = 0.67), hours on mechanical ventilation (p = 0.41), or mortality (p = 0.34) in those patients who received oseltamivir within 48 hours of symptom onset versus those who did not. Conclusions: High variation existed in observed oseltamivir prescribing practices. Future studies should incorporate multiple influenza seasons to permit a larger sample size and involve multiple facilities to allow for greater generalizability.
    • Utilization of electronic order sets based on the Center for Disease Control’s Surviving Sepsis Campaign guidelines in a community hospital

      Campbell, Ashley; Weibel, Jamie; Bhattacharjee, Sandipan; Soontornprueksa, Supranee; Raheem, Farah; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims To evaluate the impact of providers’ adherence to selecting order sets based on the Center for Disease Control’s Surviving Sepsis Campaign (CSSC) guidelines when treating sepsis at a community hospital, while secondarily exploring outcomes of this population, including in-hospital mortality and length of stay. Methods This was a retrospective, single-center study. Patients were included if they were 18 years and older with a diagnosis of sepsis at any time during their admission between August 2014 and December 2016. Use of CSSC guideline-based electronic order sets, age, gender, hospital length of stay, and in-hospital all-cause mortality were collected from the electronic health record. Descriptive statistics were used to analyze the data. Main Results A total of 451 patients diagnosed with sepsis at any time during their hospitalization between August 2014 and December 2016 were identified. All patients met the inclusion criteria. Of the 451 admissions, 32.1% were treated based on the CSSC guideline-based electronic order sets. Of the overall study sample, 9% expired during hospitalization and the average hospital length of stay for the entire study population was 5.8 ± 4.8 days. Conclusions During the 28-month study, prescribers adhered to the CSSC guideline-based electronic order sets in less than one-third of the identified sepsis cases, prompting a need for further exploration into the reasons for lack of use and possible re-education of providers on the availability of these order sets.